Outbreak of Anthrax Associated with Handling and Eating Meat from a Cow, Uganda, 2018

A nthrax is an acute zoonotic bacterial infection caused by Bacillus anthracis, a gram-positive, spore-forming bacteria that is thought to survive for as long as decades in the carcasses and burial sites of infected animals (1).Anthrax is transmitted to humans through handling or eating meat from infected animal carcasses, contact with their products (e.g., hair, wool, hides, bones), or by breathing in spores (1,2).Human anthrax infection is classified into 4 forms, depending on the route of exposure, each with a different incubation period: cutaneous (1-12 days), inhalational (1-60 days), gastrointestinal (1-6 days), and injectional (1-10 days) (3).Cutaneous anthrax is the most frequently reported form of human anthrax infection, accounting for up to 95% of cases (4).Both cutaneous and gastrointestinal anthrax outbreaks have been associated with handling or butchering infected animals and consuming their meat (5).It is estimated that each year 2,000-20,000 human anthrax cases occur worldwide (6).Most reported anthrax outbreaks occur in endemic areas in sub-Saharan Africa and Asia (1).On April 20, 2018, the Kween District of Uganda reported to the Ministry of Health 7 suspected cases of cutaneous anthrax from 2 neighboring villages, Kaplobotwo and Rikwo.We investigated to verify the existence of an anthrax outbreak, determine its scope, identify possible exposures, and recommend evidence-based control and prevention measures. Methods Study AreaKween District is located in eastern Uganda (Figure 1).It is one of the so-called "cattle-keeping corridor" districts, where cattle-rearing is a major agriculture activity. Case DefinitionFor this study, we defined a suspected cutaneous anthrax case as onset of skin vesicle or eschar, ≥2 cutaneous signs and symptoms (e.g., itching, redness, swelling), or any cutaneous sign or symptom plus regional lymphadenopathy, that occurred in a resident of Kaplobotwo and Rikwo during April 11-25,